Psychological therapies

Psychological therapy
The fact that the administration of placebos reduces pain shows that the psychic constitution has a great effect on pain perception.Psychological care of pain patients is indicated especially in chronic pain and includes for example relaxation training, hypnosis, behavioural therapy and psychotherapy.

One particular psychological treatment approach that has been found to be highly effective in helping patients to reduce pain, disability and distress is Cognitive Behavioral Therapy (CBT), which involves modifying negative thoughts related to pain and on increasing a person’s activity level and productive functioning.

CBT for pain management is tailored to the individual needs of the patient but may include:

Relaxation Training

Cognitive Restructuring

Stress and Anger Management

Sleep Hygiene

Activity Pacing

Other therapeutic approaches are e.g. hypnosis and biofeedback

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Peripheral stimulation and interventional therapy

TENS

Transcutaneous electrical nerve stimulation (TENS) TENS is a stimulation procedure to activate endogenous pain inhibition systems at the spinal and supra-spinal level. Electrodes are applied to the skin in the region of the pain, in the direct vicinity, or also over trigger or acupuncture points, and set at a special frequency, usually depending on the nature of the pain.AcupunctureAcupuncture is a method of treatment originating from Chinese medicine, which has been very successful in the treatment of pain. Fine needles are inserted into the cutaneous areas with an accumulation of sensory cells (acupuncture points). Pain-inhibiting substances, e.g. endorphins, are thus presumably released, which inhibit the transmission of the pain impulse. In addition, an electrical current can be applied to the needles.Neurosurgical procedures The basic principal of neurosurgical procedures is the interruption of the transmission pathways which transmit the pain stimuli from the damaged tissue. In chordotomy the spinothalamic tract is interrupted in the spinal cord. A less radical method is radicotomy, where surgery is not performed directly in the spinal cord, but the nerve root is severed at its exit from the spinal column. Peripheral nerves may also be blocked, either reversibly with local anaesthetics as transmission blockade or irreversibly as neurolysis using neurolytics (alcohol, phenol, etc.), electrocoagulation or irradiation. As these techniques cause permanent nerve damage, they are “last resort” treatments for the relief of very severe intractable pain.

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Education of the patient and relatives

Learning about chronic pain and its management

Patients and relatives can benefit from understanding more about their pain and its management1.

Pain education for patients and relatives includes:

Explanation of the biopsychosocial pain model

Basic information on physiology, anatomy

Explanation that inactivity leads to more pain, and activity to a reduction of the pain

Understanding pharmacological principles

Patients can be familiarised with non invasive procedures such as acupressure and transcutaneous electrical nerve stimulation

The WHO guidelines for chronic pain therapy were originally developed for chronic cancer pain. However, they are widely used as guidelines for chronic non-cancer pain treatment as well. According to the WHO ladder, treatment decisions are mainly based on pain intensity.1

Chronic pain is often multifactorial in nature and rational pain management should be based on underlying mechanisms.2

There are also several other guidelines for the treatment of specific chronic pain indications.

Which of the following elements don’t belong to Cognitive Behavioral Therapy (CBT):

Activity Pacing

Acupuncture

Relaxation Training

Cognitive Restructuring

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Congratulations

Thank you for participating in the sixth basic module “Multimodal pain management”. We hope you enjoyed it. The PAIN EDUCATION platform provides more eModules concerning pain therapy. If you like to, please continue with these eModules and check your knowledge.